Marine Injury

Aka: Marine Injury, Marine Envenomation, Marine Trauma, Marine Animal Bite, Venomous Fish Sting

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II. Causes: Marine Injury

  1. Anaphylactic reactions (if allergic)
    1. Anemone string
    2. Jellyfish sting
  2. Marine Envenomation
    1. See Neurotoxin
    2. Cnidaria
      1. Jellyfish
      2. Portuguese Man-Of-War
      3. Hard Coral
      4. Fire Coral
      5. Anemone
    3. Echinoderms
      1. Starfish
      2. Sea Urchins
        1. Sharp spines are filled with venom (blunt spines do not bear venom)
    4. Stingrays (Chondrichthyes)
    5. Cottonmouth, water moccasin (Agkistrodon piscivorus)
    6. Sea Snake (Southeast Asia, Persian gulf, Malaysia)
    7. Octopus (Blue-ringed and spotted)
    8. Cone Shell (Australia, New Guinea, California)
    9. Candiru (toothpick fish, vampire fish)
      1. South American small, parasitic catfish living in the Amazon Basin
      2. May invade the human Urethra
    10. Scorpion Fish, Lion Fish, Sculpins and Stonefish (Scorpion Fish Family)
      1. Stinging spines on the dorsal, pelvic and anal regions
      2. Local tissue Hemolysis, Smooth Muscle relaxation, weakness, hyaluronidase release
      3. Envenomations may be more severe than Stingrays
      4. Antivenom exists for stonefish
      5. See Stingray for sting management
    11. Catfish
      1. Venomous spines in the dorsal and pectoral fins
      2. Local tissue necrosis, Hemolysis, edema and vasospasm
      3. See Stingray for sting management
    12. Sea Sponges (Touch-me-not and Fire sponge)
    13. Bristle worms (Fire Worms)
  3. Marine Animal Bites
    1. See Animal Bite
    2. Moray eel
    3. Barracudas
    4. Sharks
  4. Other Trauma
    1. Abrasions or Lacerations from coral or sharp rocks
      1. Most common cause of Marine Injury
      2. High risk of infection
  5. Pruritus after water exposure
    1. See Aquagenic Pruritus
    2. Swimmer's Itch (Fresh water exposure)
    3. Seabather's Eruption (Salt water exposure)
      1. Type of Cnidaria Envenomation

III. Management: General Injury

  1. See specific marine organism for management
  2. Remove patient from water (do not remove wet suit)
  3. ABC Management with control of bleeding sites
  4. Be alert for Anaphylaxis (esp. Jellyfish or anemone Envenomation)
    1. Epinephrine IM Injection
  5. Manage Envenomations in similar way to Stingray
    1. First immerse in tolerably hot water for 30 min
    2. Purple wound discoloration may be dye from the spine, or retained spine
    3. If able, remove embedded spine, but do not crush
    4. Refer to orthopedics, if retained spine not removable or near joint
  6. Identify cause of injury if possible
  7. Wound management
    1. Standard wound care
      1. See Wound
      2. See Wound Repair
      3. Copious irrigation
    2. Consider primary closure only if absolutely necessary
      1. Sutures should be loose enough to allow drainage
      2. Contraindication to suturing or closure
        1. Puncture Wound
        2. Crush injury
        3. Wound involving distal hands or feet
  8. Observe for signs of infection
    1. Most common Bacterial organisms
      1. See Cellulitis
      2. Vibrio vulnificus (Vibrio Cellulitis, high risk of rapid progression)
      3. Vibrio alginolyticus
      4. Vibrio parahaemolyticus
      5. Aeromonas Hydrophila
    2. Other Bacterial Infections
      1. Erysipelothrix rhusiopathiae (Erysipeloid, fish handler's disease)
      2. Streptococcus iniae (from farmed tilapia)
      3. Mycobacterium marinum (Fish tank exposure)
      4. Spines of stonefish (South Pacific) risk of serious systemic toxicity, Pulmonary Edema
    3. Treat Cellulitis early if observed
      1. Select Antibiotics to cover Vibrio Cellulitis
    4. Prophylaxis is usually not indicated

IV. References

  1. Auerbach (2017) EM:Rap 17(10):6-7
  2. Habif (1996) Dermatology, p. 491
  3. Tomaszewski (2020) Crit Dec Emerg Med 34(9): 28
  4. Jain (2003) Emerg Med Clin North Am 21(4):1117-44 [PubMed]
  5. Perkins (2004) Am Fam Physician 69(4): 885-90 [PubMed]

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